Basic Information
| Provider Information | |||||||||
| NPI: | 1205991080 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KURTZMAN | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | SETH | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 708 S CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280544548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048426354 | ||||||||
| FaxNumber: | 7048426393 | ||||||||
| Practice Location | |||||||||
| Address1: | 708 S CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280544548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048426354 | ||||||||
| FaxNumber: | 7048426393 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 1075 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 6102851 | 05 | NC | MEDICAID |